title: Clinical and economic consequences of pancreatic fistula after elective pancreatic resection.
abstract: BACKGROUND
  Postoperative pancreatic fistula is the main cause of morbidity after pancreatic resection. This study aimed to quantify the clinical and economic consequences of pancreatic fistula in a medium-volume pancreatic surgery center.
  
  
  METHODS
  Hospital records from patients who had undergone elective pancreatic resection in our department were identified. Pancreatic fistula was defined according to the International Study Group on Pancreatic Fistula (ISGPF). The consequences of pancreatic fistula were determined by treatment cost, hospital stay, and out-patient follow-up until the pancreatic fistula was completely healed. All costs of the treatment are calculated in Euros. The cost increase index was calculated for pancreatic fistula of grades A, B, and C as multiples of the total cost for the no fistula group.
  
  
  RESULTS
  In 54 months, 102 patients underwent elective pancreatic resections. Forty patients (39.2%) developed pancreatic fistula, and 54 patients (52.9%) had one or more complications. The median length of hospital stay for the no fistula, grades A, B, and C fistula groups was 12.5, 14, 20, and 59 days, respectively. The hospital stay of patients with fistula of grades B and C was significantly longer than that of patients with no fistula (P<0.001). The median total cost of the treatment was 4952, 4679, 8239, and 30 820 Euros in the no fistula, grades A, B, and C fistula groups, respectively.
  
  
  CONCLUSIONS
  The grading recommended by the ISGPF is useful for comparing the clinical severity of fistula and for analyzing the clinical and economic consequences of pancreatic fistula. Pancreatic fistula prolongs the hospital stay and increases the cost of treatment in proportion to the severity of the fistula.
authors.affiliation: Department of Surgery, Faculty of Medicine and University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic. filip.cecka@seznam.cz.
authors.forename: Filip
authors.initials: F
authors.lastname: Čečka
authors.forename: Bohumil
authors.initials: B
authors.lastname: Jon
authors.forename: Zdeněk
authors.initials: Z
authors.lastname: Šubrt
authors.forename: Alexander
authors.initials: A
authors.lastname: Ferko
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D003365:Costs and Cost Analysis; D017558:Elective Surgical Procedures; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000191:economics*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000191:economics* / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome